A Case of Buccal Pilomatricoma Removed Through Intraoral Incision / 대한두경부종양학회지

Pilomatricoma(or calcifying epithelioma) is a not common benign solitary tumor originated from outer root sheath cell of hair follicle or hair follicle of sebaceous glands. The tumor usually presents as an asymptomatic, hard, superficial located, and skin colored to reddish blue cutaneous mass. Most of the tumors are less than 10mm in diameter and adherent to the skin. Recently, 48-year-old man presented with cheek mass. The tumor was 2.6cm sized and located at the subcutaneous layer of cheek on CT scan. The tumor was clearly removed via transoral approach with buccal incision leaving no wound on face. The mass was confirmed as pilomatricoma on pathologic examination. Herein, we report our experience with literature review.

Accuracy of Diagnostic Methods for Detection of Head and Neck Primary Origin in Metastatic Neck Mass / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: It is important to localize the primary site when cervical lymph node metastasis is detected. The purpose of this study was to evaluate the accuracy of diagnostic methods to detect the head and neck primary site in patients with metastatic neck mass. SUBJECTS AND METHOD: Sixty-six patients who had presented with neck mass and were confirmed to have metastatic carcinoma by fine needle aspiration cytology from January 1998 to June 2016 were enrolled. We analyzed the accuracy of diagnostic modalities that inluded physical and endoscopic examination, CT, MRI, PET/CT, and guided biopsy. RESULTS: The mean age of patients was 58.7±12.6 years with the male to female ratio of 55:11. The metastatic lymph nodes were most common at level II (60/66, 90.9%) followed by levels III, IV, I and V. The most common primary site was tonsil (45.5%), followed by the nasopharynx, base of tongue and hypopharynx, and eight patients (12.1%) were diagnosed as metastatic carcinoma of unknown origin. The primary sites were detected by: physical and endoscopic examination in 36/66 (54.5%), CT in 41/66 (62.1%), MRI in 39/52 (75%) and PET/CT in 46/63 (73.1%). The primary sites were additionally detected using PET/CT for nine cases of the 20 cases, where primary sites were not found using physical and endoscopic examination, CT or MRI. Guided biopsy was done in 11 cases, where primary sites were not detected by all of the methods; hence, primary sites for 3 cases were additionally revealed. CONCLUSION: PET/CT is a useful method when physical examination, CT and MRI cannot reveal the primary site of metastatic neck mass. Guided biopsy can be performed when primary site is not founded by any of the physical and imaging examinations.

Bioballs Causing Asymptomatic or Recurrent Acute Rhinosinusitis: Two Cases

A variety of intrinsic and extrinsic factors have been studied to explain the pathogenesis of rhinosinusitis. Recently biofilms are emerging as an important cause. Biofilms are highly organized structures composed of a protective extracellular matrix and bacterial colonies, and provide the means for bacterial survival and virulence. Biofilms are known to be associated with intractable cases of rhinosinusitis and antibiotic resistance. Patients diagnosed with biofilm-related rhinosinusitis tend to suffer more severe disease that those without biofilms. Biofilm severity can also influence the prognosis of rhinosinusitis. We present two cases of pseudomonas-induced macroscopic biofilms (bioballs) of the maxillary sinuses. These bioballs cause intractable chronic rhinosinusitis as well, but unlike traditional biofilms, they can be surgically removed by endoscopy, and thus have a better prognosis than traditional biofilms. This is the first report of visible biofilms (bioballs) found in the maxillary sinuses.

Clinical Characteristics of Traumatic Benign Paroxysmal Positional Vertigo Compared with Idiopathic Benign Paroxysmal Positional Vertigo / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Benign paroxysmal positional vertigo (BPPV) is one of the most common diseases in patients with dizziness after head trauma. The aim of the study was to investigate the clinical characteristics of the traumatic BPPV (tBPPV) compared with idiopathic BPPV (iBPPV). SUBJECTS AND METHOD: From January 2008 to June 2015, a retrospective review was performed on 572 patients diagnosed with BPPV and treated with appropriate canalith reposition maneuver. Clinical characteristics of patients, such as age, sex, affected semicircular canal, and number of reposition maneuver were evaluated and compared between iBPPV and tBPPV. Canal change and recurrence rate were also assessed. RESULTS: Among 572 BPPV patients, 509 were iBPPV and 63 were tBPPV. The male to female ratio was higher in tBPPV (26/37) than in iBPPV (142/367) (p=0.028). Posterior semicircular canal (PSCC) was more commonly affected than lateral semicircular canal in the tBPPV group compared with the iBPPV group (38/18 vs. 244/257). Also multiple canal was more commonly affected in the tBPPV group than in the iBPPV group (11.11/3.54%) (p=0.001). The tBPPV group needed fewer number of canalith reposition maneuver for symptom relief than the iBPPV group did (1.35 vs. 1.53, p=0.048). The side of affected canal was more frequently changed in tBPPV than in iBPPV (22.22% vs. 11.98%, p=0.023). There was no significant difference in recurrence rate between tBPPV and iBPPV (18.87% vs. 19.25%, p=0.518). However, the tBPPV group had a tendency of earlier recurrence than the iBPPV patients (1.33 month vs. 2.86 month, p=0.050). CONCLUSION: tBPPV was more common in male and PSCC was usually affected. The tBPPV patients had a tendency of frequently changing the canal type and an earlier recurrence than the iBPPV patients. These distinguished clinical features would be useful in diagnosing and managing tBPPV patients.

The Correlation of Levels of Serum Lipid, Homocysteine, and Folate with Volumes of Hippocampus, Amygdala, Corpus Callosum, and Thickness of Entorhinal Cortex in Patients with Amnestic Mild Cognitive Impairment or Dementia of Alzheimer's Type

OBJECTIVES: In this study, the authors evaluated the correlation between levels of serum lipid, homocysteine, and folate with volumes of hippocampus, amygdala, corpus callosum, and in patients with amnestic mild cognitive impairment (aMCI) or Alzheimer's disease (AD) type. METHODS: The study recruited patients who visited the dementia clinic of Haeundae Paik Hospital in Korea between March 2010 and June 2014. Among those, patients who had taken the neurocognitive test, brain magnetic resonance imaing, tests for serum lipid, homocysteine, folate, and apolipoprotein E (APOE) genotyping and diagnosed with aMCI or AD were included for analysis. Bilateral hippocampus, entorhinal cortex, amygdala and corpus callosum were selected for region of interest (ROI). The cross-sectional relationships between serum lipid, homocysteine, folate and ROI were assessed by partial correlation analysis and multiple linear regression analysis. RESULTS: In patients with aMCI, old age (> 80) and APOE epsilon4 carrier were associated with AD [odds ration (OR) : 12.80 ; 95% confidence interval (CI) : 2.25-72.98 and OR : 4.48 ; 95% CI : 1.58-12.67, respectively]. In patients with aMCI or AD, volumes and thickness of ROI were inversely correlated with levels of serum lipid and homocysteine. In multiple linear regression analyses, higher total cholesterol level was related to lower left, right hippocampus volume and left amygdala volume ; higher low-density lipoprotein cholesterol was related to lower right entorhinal cortex thickness ; higher homocysteine level was related to lower corpus callosum volume. CONCLUSIONS: Higher serum lipid and homocysteine levels are associated with decreased volume of hippocampus, amygdala, corpus callosum and entorhinal cortex thickness in patients with aMCI or AD. These findings suggest that serum lipid and homocysteine levels are associated with AD as a modifiable risk factor.

A case of ruptured renal cortical arteriovenous malformation of the right testicular vein in hemorrhagic fever with renal syndrome

Hemorrhagic fever with renal syndrome (HFRS) is an acute viral disease characterized by fever, hemorrhage, and renal failure. Among the various hemorrhagic complications of HFRS, the spontaneous rupture of an arteriovenous malformation of the testicular vessels with a retroperitoneal hematoma is a rare finding. Here, we report a case of HFRS complicated by a massive retroperitoneal hematoma that was treated with transcatheter arterial embolization.

Kidney Length in Normal Korean Children

PURPOSE: Renal length offers important information to detect or follow-up various renal diseases. The purpose of this study was to determine the kidney length of normal Korean children in relation to age, height, weight, body surface area (BSA), and body mass index (BMI). MATERIALS AND METHODS: Children between 1 month and 15 years of age without urological abnormality were recruited. Children below 3rd percentile and over 97th percentile for height or weight were excluded. Both renal lengths were measured in the prone position three times and then averaged by experienced radiologists. The mean length and standard deviation for each age group was obtained, and regression equation was calculated between renal length and age, weight, height, BSA, and BMI, respectively. RESULTS: Renal length was measured in 550 children. Renal length grows rapidly until 24 month, while the growth rate is reduced thereafter. The regression equation for age is: renal length (mm) = 45.953 + 1.064 x age (month, 24 months) (R2 = 0.711). The regression equation for height is: renal length (mm) = 24.494 + 0.457 x height (cm) (R2 = 0.894). The regression equation for weight is: renal length (mm) = 38.342 + 2.117 x weight (kg, 18 kg) (R2 = 0.651). The regression equation for BSA is: renal length (mm) = 31.622 + 61.363 xBSA (m2, 0.7) (R2 = 0.715). The regression equation for BMI is: renal length (mm) = 44.474 + 1.163 x BMI (R2 = 0.079). CONCLUSION: This study provides data on the normal renal length and its association with age, weight, height, BSA and BMI. The results of this study will guide the detection and follow-up of renal diseases in Korean children.

Portal Vein Occlusion after Biliary Metal Stent Placement in Hilar Cholangiocarcinoma

Acute symptomatic portal vein obstruction related to biliary stenting is an extremely rare but life-threatening complication. This usually occurs in patients with either tumor invasion into the portal vein or pre-existing portal vein thrombus. Therefore, the portal vein should be carefully evaluated before placing a biliary metallic stent in such patients. We describe a case of acute portal vein obstruction after placing metallic biliary stents in a patient with a periductal-infiltrating type of hilar cholangiocarcinoma.

Metastatic Hemangiopericytoma of the Liver: A Case Report

A hemangiopericytoma is a rare soft tissue sarcoma that originates from pericytes. This neoplasm can occur in any part of the body but their frequent sites of origin are reported to be the lower extremities, pelvis, retroperitoneum, head, neck and trunk. A hemangiopericytoma may be curable by a surgical resection but its prognosis is poor when it recurs. Distant metastases rarely occur and the most commonly affected organs are the lung and bone. At CT, a hemangiopericytoma is typically depicted as a hypervascular tumor with a delayed fill-in of contrast enhancement from the periphery. We encountered a case of hemangiopericytoma that metastasized to the liver. We describe the radiological findings of the metastatic hemangiopericytoma of the liver.

Non-Functional Retroperitoneal Paraganglioma Mimicking an Ovary Mass: A Case Report

The paraganglioma is rare neuroendocrine tumor arising from paraganglionic tissue and most cases show characteristic endocrinological symptoms that are caused by catecholamine secretion. We report here on a case of nonfunctioning retroperitoneal paraganglioma that did not show any neuroendocrine symptoms, and this was misdiagnosed as ovarian tumor by ultrasonography and CT.

Non-Functional Retroperitoneal Paraganglioma Mimicking an Ovary Mass: A Case Report

The paraganglioma is rare neuroendocrine tumor arising from paraganglionic tissue and most cases show characteristic endocrinological symptoms that are caused by catecholamine secretion. We report here on a case of nonfunctioning retroperitoneal paraganglioma that did not show any neuroendocrine symptoms, and this was misdiagnosed as ovarian tumor by ultrasonography and CT.

Angiolipoma in the Cerebellopontine Angle: A Case Report

A 65-year-old female, who suffered with a longstanding headache, was admitted to our hospital. MR imaging and digital subtraction angiography (DSA) demonstrated a vascular fat-containing mass in the right cerebellopontine angle. The lesion was surgically removed and the diagnosis of angiolipoma was established. The symptoms subsided after the operation.

Quality Assurance of Ultrasonic Diagnosis in Breast

Sonography is a subjective diagnostic method which is highly dependent on the experience of the operator and the equipment quality which requires real-time adjustments. Breast screening examination currently consists of clinical examination and mammography. Breast sonography, either supplementary to mammography or independently, is indicated for the dense breast, especially in younger women. Breast sonography is especially applicable for Korean women because of the denser breast parenchyma and the approximately 10-year younger incidence rate of breast cancer of Korean women compared to western women. To avoid unnecessary breast biopsy because of the high rate of false positive lesions in breast parenchyma, which is different from other body organs such as the liver or the kidney, a quality assurance program for breast sonography is essential. The quality assurance of breast ultrasound involves quality assurance of the equipment, imaging display and acquisition of clinical images, personnel qualifications and other aspects such as unification of lexicon, guideline of diagnostic examination and reporting system; US BI-RAD reporting system, assessment items and organization, education program, medical audit, certification issues, and medicolegal issues. A breast sonographic quality assurance system should be established before a scheme to initiate governmental medical insurance for breast sonography.

A Case of progressive elevation of serum gamma-GTP level in ataxia-telangiectasia / 대한소아신경학회지

Ataxia-telangiectasia is an autosomal recessive disorders characterized by cerebellar ataxis, oculocutaneous telangiectasia and frequent respiratory infections due to immunoincompetence. Ataxia usually appear by age of 2 years with most patients need wheelchairs for morbility by early teenage. Speech and eye movements are also affected. Other important features are immunodeficiency, a high level of serum alpha-fetoprotein concentration, growth retardation, telangiectasia and a very high risk of a lymphoid tumor. Patients also show an increased sensitivity to ionizing radiation. We report a case of a 7-year-old girl who had ataxic gate, conjunctival telangiectasia, and frequent upper respiratory infection. Her alpha-fetoprotein was elevated and the serum IgA was decreased. The brain MRI showed prominent cerebellar atrophy. From the 1 st year of life to death, the level of serum gamma- GTP became steadily elevated up to 10 times of a normal level.

A Case of Pneumococcal Meningitis Associated with Posttraumatic Cerebrospinal Fluid Rhinorrhea / 대한소아신경학회지

Bacterial meningitis after head trauma is a rare complication, but the cerebrospinal fluid(CSF) leakage after head trauma greatly increases the risk of bacterial meningitis. Most of the infections passes through the defects in the basal skull fracture, and Streptococcus pneumoniae is the most common organism. MRI, coronal thin sections of cranial CT and radioiosotope cisternography are considered to diagnose the CSF fistulae. We report a case of a 14-year-old girl with pneumococcal meningitis complicated by CSF rhinorrhea following an asymptomatic period of 3 years after head trauma. We found a bone defect of the cribrium of the skull base by means of paranasal sinus CT scanning and MRI.

Hyperprolactinemia After Severe Head Trauma

Patients of head injury may manifest neurohypophyseal dysfunction during the early post-traumatic period. A case of hyperprolactinemia and low prolactin response to thyrotrophin-releasing hormone in a woman 7 months after severe head injury is presented and literatures are also reviewed.

Radiologic Findings of Direct Splenic Invasion by Malignant Tumors of Adjacent Organs

PURPOSE: To evaluate the radiologic findings of direct invasion of the spleen by malignant tumors of adjacent organs. MATERIALS AND METHODS: We retrospectively reviewed the CT(n=6) and MR(n=3) images of six patients with direct invasion of the spleen by malignant tumor of left lower lung, stomach, colon, pancreas, left kidney, and left adrenal gland. We evaluated the tumor margin, attenuation or intensity, perisplenic fat infiltration, regional lymphnode enlargement, and invaded site of the spleen. RESULTS: Ill-defined masses were found in the spleen with central necrosis and infiltration into perisplenic fatty tissue in all six patients; left adrenal mass was present also in three patients. Regional lymphnode enlargement was found in four patients. The masses showed heterogenous low attenuation on CT. The invaded site was variable and corresponding to their anatomical connections to the spleen. CONCLUSION: Direct invasion of the spleen by malignant tumors of adjacent organs showed ill-defined masses with central necrosis and were commonly associated with infiltration to perisplenic fatty tissue and adrenal invasion. The pattern and invaded site can be helpful to assess the primary cancer.

A Case of Cerebral Gigantism(Sotos Syndrome) / 대한소아내분비학회지

Cerebral gigantism(Sotos syndrome) is a growth disorder that consists of large size at birth, rapid early growth rate with accompanying advanced bone age, acromegalic features, and developmental delay. Clumsiness in the absence of other abnormal neurologic findings is common. The cause is unknown. We report here a case of 238/12-year-old Sotos syndrome with final adult height above 97 percentile, abnormal brain MRI findings(large ventricles, prominent trigone, prominent occipital horn & thining of corpus callosum), clumsiness, and some behavioral problems.

The Usefulness of T2* Weighted Magnetic Resonance Image in the Diagnosis of Minute Traumatic Intracerebral Hemorrhage

OBJECTIVE: This study is performed in order to compare T2* weighted magnetic resonance(T2*W MR) image to computerized tomography(CT) and conventional magnetic resonance(MR) image for the detection of minute traumatic intracerebral hemorrhage. METHODS: A series of 40 patients with head trauma underwent CT and MR image including T2*W MR sequnence. The authors compared T2*W MR image to CT and conventional MR image in the diagnosis of traumatic intracerebral hemorrhage. RESULTS: Thirty five of 40 patients(88%) were revealed the hemorrhagic foci in the T2*W MR image, whereas 30 patients(75%) were revealed in the conventional MR image, 18 patients(45%) in the CT. Therefore it is concluded that T2*W MR image is more sensitive than CT or conventional MR image in the diagnosis of minute traumatic intracerebral hemorrhage in patients with head trauma. CONCLUSION: If headache is persisted in the head trauma patients with negative CT and MR image finding, We recommend T2*W MR image.

The Significance and Limitation of MR Volumetry: Comparison between Normal Adults and the Patients with Epilepsy and Hippocampal Sclerosis

PURPOSE: Hippocampal atrophy is one of the characteristic pathologic findings of hippocampal sclerosis, for which MR imaging of the hippocampus is essential in the evaluation of hippocampal sclerosis. The purpose of this study is to present the normal MR volumetric data of the hippocampus in normal adult Korean and to compare those with MR volumetric data of hippocampus in patients with hippocampal sclerosis, providing the diagnostic volume criteria of the hippocampal atrophy. MATERIALS AND METHODS: MR volumetry was performed in 30 normal adults and 28 patients with temporal lobe epilepsy whose final diagnosis was hippocampal sclerosis. The volumetric data were compared between sexes, right and left sides, and normal and abnormal hippocampus, and the volume criteria for the diagnosis of hippocampal atrophy was determined. RESULTS: The mean volumes(+/-standard deviation) of normal Korean adult were 2.20+/- 0.73 cm3 (right) and 2.17+/-0.72 cm3 (left) in male and 2.27+/-0.47 cm3 (right) and 2.23 +/-0.48 cm3 (left) in female. The mean right-left differences were 0.14+/-0.11 cm3 and 0.19+/-0.13 cm3 in male and female, respectively. The MR volumetry showed no significant statistical differences between sexes and between right and left. The mean volume and standard deviation of the hippocampus in hippocampal sclerosis patients was 1.46+/-0.60 cm3, and the right-left difference was 0.51+/-0.41 cm3. In comparison of two volume distributions between normal adult group and hippocampal sclerosis patients group, the reasonable diagnostic volume criteria was 0.4 cm3 as right-left volume difference, in which the sensitivity and specificity are 0.61 ant0.90. In all patients with right-left volume difference more than 0.4 cm3, visual determination of unilateral hippocampal atrophy was possible. CONCLUSION: The MR-based hippocampal volumetry is a useful add-on of visual MR diagnosis, only when visual diagnosis of hippocampal sclerosis is difficult.